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Thursday, January 17, 2013

Early Intervention and Autism – Hooked on Research

From The Doctor's Tablet - The Albert Einstein College of Medicine Blogby Lisa Shulman, M.D.January 15, 2013
I have an admission to make: I am an early-intervention junkie. I reach for professional journals about early intervention the way my husband approaches the sports page. Early intervention is predicated on the theory that the brains of young children have a plasticity that allows them to change and even get “reprogrammed”—thereby affecting their learning and behavior. It is an intoxicating notion. . . .

As a developmental pediatrician specializing in the diagnosis and care of young children with autism, I usually find plenty of reading material to get me my early-intervention fix.

In my clinical work, I (like others) have found one group of young children with autism of particular interest—not only because of the children’s unique history, but because of what their example may suggest about all young children with autism. These are the approximately 30 percent of children with autism whose parents report a loss of words (language regression) early on in the children’s development. The parents often give histories such as this:

The child, generally between 15 and 21 months, was just beginning to say words, with maybe two or three definite words so far. Then, over a period of time, the parents began to note that the child was using his or her words less frequently and making fewer efforts to communicate with gestures (such as waving bye-bye or pointing) or to play interactive games (such as peek-a-boo). Because the skills were really just emerging, the parents often appreciated this pattern only over time.

In retrospect, the parents made other observations as well, such as that the child was spending more time involved in solitary endeavors—inspecting blocks closely, spinning the wheels of toy cars, watching the numbers on the front of the DVD player change, or repeatedly opening and closing the doors in the house.

This history, heard again and again, made me appreciate how a young child could gradually change in ways that took him or her further away socially, while the child’s peers were developing more social and communicative expertise. Step by step, day by day, the social connections became weaker.

The child slowly slipped away.

So if children can slip away, the obvious question is: what can be done to bring them back?

Research on early intervention for autism in general (not just for those children with regression) has shown that intensive behavioral intervention begun early is associated with the best outcomes. One evidence-based intervention, the Early Start Denver Model, involves providing young children with autism 15 hours a week of individualized behavioral intervention with trained therapists and another 16 hours a week of intervention carried out by the children’s parents.

The treatment can be initiated with children as young as 18 months.

After two years of treatment, the children were found to have made significant gains in IQ, in the ability to use and understand language and in adaptive behavior. It makes sense to me; the language and social losses had been slow and gradual, so a therapeutic approach designed to encourage gains would need to be painstaking as well.

I was thrilled recently to find that Time Magazine’s list of the Top 10 Medical Breakthroughs for 2012 included “Hope for Reversing Autism,” focusing on a study of children who had participated in the Early Start Denver model. The study took the results one step further by showing that after two years of the program, children with autism showed a reversal of the specific patterns of brain-wave activity generally seen in such children. (Usually children with autism show more brain activity when viewing images of inanimate objects than when observing a human face.

But after two years of the intensive program, the children with autism displayed the brain-wave patterns seen in typically developing children: more brain activity when looking at a human face than when regarding images of inanimate objects.)

This groundbreaking study provides the first physiologic evidence that it is possible, with early and intensive intervention, to halt and possibly reverse some of the brain changes in autism that presumably underlie the developmental patterns (social, communication and atypical-interest) seen in these children.

If children can drift away from social connections gradually, so too can they be reconnected by intensive therapy provided over time. This study is a top 10 medical breakthrough because it gives us physiologic data showing that the heretofore theorized plasticity of the brains of young children—which permits response to early intervention—is real. Music to an early-intervention junkie’s ears.

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